I was officially diagnosed with Parkinson’s disease (PD) at age 62, although I've had tremors (along with what I now recognize were other, less obvious PD symptoms) for many years prior. I was told by numerous physicians not to be concerned regarding the tremors; essential tremors are not uncommon, so I pretty much ignored the red flags.
In early 2020 I found that I was having an extremely difficult time initiating a step when walking, so I decided to check with my PCP. In February 2020, while doing my physical exam, a small town, country doctor noticed the twitching in my fingers. The tremors combined with my start hesitation resulted in a recommendation that I see a neurologist. The rest, as they say, is history.
After receiving my diagnosis, I did extensive research on the Internet and found the Parkinson's Foundation website to be outstanding. Their online information library was extremely helpful in learning more about PD, and I have assembled quite a collection of wonderful info about PD thanks to their resources.
We had a very nice little cabin in rural, northern New Mexico, but the medical care was lacking in the area for someone with PD. When I retired, we moved to the Albuquerque metro area. I miss the beauty, solitude and seclusion of the Sangre de Cristo mountains, but I found a movement disorders specialist in Albuquerque and she has been absolutely awesome.
I am basically learning how to overcome the challenges of being a person with Parkinson’s disease by having access to opportunities that were not readily available prior to relocating. I actually feel blessed, and I refuse to be defined by Parkinson’s. My life, even with the daily rigors of dealing with a progressive disease, has been very rewarding!
I am reminded of a quote which, for a person with PD, I believe are words to live by:
"We cannot change the cards we are dealt, just how we play the hand."
The Parkinson’s Foundation is here to help. Explore Parkinson’s disease resources in our PD Library.
I have always believed the old adage that if you feel something is off or wrong, then it probably is. Life began to change when I could no longer teach my fitness classes without extreme muscle spasms, when I couldn't complete a 5K due to leg pain and weakness, when my hand began to shake without explanation and when going to work as a physical education teacher caused a level of fatigue and brain fog that I had never experienced. Each of these symptoms caused me to fear that I would no longer be able do the things I loved.
I was under the care of both a great chiropractor and physical therapist who urged me to find answers when there seemed to be none. It became a guessing game and a myriad of tests that never produced the answer. No one could tell me what was wrong, so how I was supposed to get back to normal?
After almost a year of testing in my local area and being told many different things without solutions, I reached out to a major research hospital which was seven and a half hours away from my home. Luckily, I was accepted as a patient and when I walked in the doors, I knew that I was in the correct place.
After a series of visits, I received a telephone call that would change my life and give me an answer to what had been ailing me for almost two years. The physician informed that she believed I had young-onset Parkinson's disease (YOPD).
While I never expected this diagnosis, I knew that Parkinson’s was manageable because I have a coworker who was also diagnosed with YOPD several years ago. Once I started medication, I began to get my life back. My movement disorders specialist told me about the Parkinson’s Foundation and the resources available for people living with PD. I was able to virtually attend a symposium to learn more about the disease.
I still can't run like I did before YOPD symptoms began, but I can box, teach my fitness classes and lift weights effectively. When I’m at home, I use Fitness Friday videos to stay moving. I learned that it is imperative to stand up for yourself and not give up on answers. If you ever find yourself on a diagnosis journey, don't give up! I believe that had I not continued to search for answers, my condition would have been much worse before I knew the cause of my symptoms.
I now choose to spread awareness of YOPD through education, exercise and encouragement for those living with the same condition.
A common misconception is that palliative care implies hospice, when in fact, palliative care can and should be a component of the treatment of any serious disease, including Parkinson’s. The word “palliation” means providing relief from pain and other symptoms, with a goal of improving quality of life. Individuals receiving palliative care also may receive other treatments, with curative intent if available. On the other hand, palliation can be a part of hospice, but in hospice, a person no longer has curative options or chooses not to pursue them. In this episode, Maggie Ivancic, MSW, LCSWA, the Clinical Social Worker and Parkinson’s Foundation Center of Excellence Coordinator at the University of North Carolina at Chapel Hill, discusses aspects of palliative care – how it differs from hospice, its intent, and how and where to access it.
Released: May 2, 2023
Maggie Parker Ivancic, MSW, LCSW, joined UNC Neurology as the social worker and center coordinator for UNC Movement Disorders Center and received her MSW from the University of North Carolina at Chapel Hill. Maggie completed her clinical internship with Duke Movement Disorders Center. Prior to joining the UNC Movement Disorders Team, Maggie worked as a hospice social worker.
Episodio 25: Opciones quirúrgicas en el tratamiento de la enfermedad de Parkinson
Aunque los medicamentos suelen ayudar a minimizar las fluctuaciones motoras de la enfermedad de Parkinson, hay ocasiones en las que la medicación no es suficiente y se plantean opciones de tratamiento avanzadas.
Es importante explorar las opciones quirúrgicas con su especialista en la EP si esto es algo que puede considerar. La cirugía a menudo se reserva para quienes han optimizado y agotado los medicamentos para el temblor de Parkinson o que experimentan profundas fluctuaciones motoras.
En este episodio de podcast, escuchamos al Dr. Gonzalo Revuelta, profesor asociado de neurología y director médico del programa de estimulación cerebral profunda en MUSC, la Medical University of South Carolina, sobre las opciones de tratamiento quirúrgico disponibles para las personas con la enfermedad de Parkinson.
Publicado: 25 de abril de 2023
Gonzalo J. Revuelta, DO, MSc, FANA, es catedrático SmartState de enfermedades neurodegenerativas y profesor asociado de neurología. Dirige el Murray Center for Research In Parkinson’s Disease and Related Disorders y es el director médico del programa de estimulación cerebral profunda en MUSC (Medical University of South Carolina). Se licenció en Medicina por la University of Medicine and Dentistry of New Jersey—School of Osteopathic Medicine. Completó su residencia en neurología en la Drexel University College of Medicine en Filadelfia. Tras la residencia, completó un entrenamiento especializado en trastornos del movimiento y estimulación cerebral profunda en la Emory University School of Medicine en Atlanta. Su investigación se centra en el desarrollo de terapias de neuromodulación para los bloqueos de la marcha en la enfermedad de Parkinson.
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Expert Briefing: Freezing and Fall Prevention in Parkinson's
April 12, 2023
While aging may put us all at an increased risk for falling, people living with Parkinson’s disease have twice the risk of their peers. Falls often result in injuries ranging from minor cuts to serious fractures, impacting mobility and quality of life. Learn how freezing and other movement and non-movement symptoms can contribute to falls and how to lessen the risk.
Colum MacKinnon, PhD
Professor, Department of Neurology, Institute of Translational Neuroscience, University of Minnesota
Podcasts
Episode 148: How to Prevent Sudden “Off” Episodes
“Off” episodes can become a troubling aspect of Parkinson’s disease (PD), especially as the disease progresses. These are periods in the day when the effect of levodopa medication wears off, either suddenly or gradually, with a return of motor or non-motor symptoms.
The good news is that there are several ways to try to minimize “off” episodes, including medication timing, medication adjustments, and add-on medications. In this podcast episode, Dr. George Kannarkat, a movement disorders fellow at the University of Pennsylvania in Philadelphia, a Parkinson’s Foundation Center of Excellence, discusses “off” episodes, their causes, strategies that people can use today to minimize them, and what new technologies are here or coming along to help lessen them.
Released: April 4, 2023
Dr. George Kannarkat is an MD-PhD trained physician-scientist who is currently finishing his Movement Disorders fellowship at the University of Pennsylvania. After fellowship, he will be staying at the University of Pennsylvania as an Instructor to continue seeing individuals with Parkinson's disease while concurrently working in the lab of Dr. Alice Chen-Plotkin. His research interests are understanding the molecular mechanisms, particularly those outside the brain, that contribute to initiating pathology seen in Parkinson's disease. His ultimate goal is to help develop technologies that identify and treat disease in early or prodromal stages. He completed medical school and his graduate training at the Emory University School of Medicine where he worked in the lab of Dr. Malu Tansey to work on peripheral immune mechanisms of neurodegeneration. He completed his neurology residency at Johns Hopkins Hospital.
Research is actively underway to develop new medications that can slow or stop Parkinson’s disease (PD) progression, while also working to improve the lives of people living with PD today. Learn how lifestyle choices and medication therapy can help you manage Parkinson’s symptoms and what is in the pipeline for 2023.
This article is based on Parkinson’s & Medications - What's New, a Parkinson’s Foundation Expert Briefing webinar presented by Tanya Simuni, MD, Northwestern University Feinberg School of Medicine, Director Parkinson’s Disease and Movement Disorders Center, a Parkinson’s Foundation Center of Excellence.
Stay Informed
For the latest about Medications explore our Treatment webpages.
Globally, Parkinson's is the most rapidly increasing neurological disease and is currently the second most common neurodegenerative disease after Alzheimer's. Researchers are prioritizing science to help them understand the biology behind Parkinson’s disease.
Genetic research is one area that shows promise to push the science forward. However, research seeking to better understand the causes of PD and clinical trials to develop promising new therapies can only happen if people participate in the studies. Participating in a study can also help those living with Parkinson’s better understand their disease.
Current Medication Options
There are several medications available today designed to help manage various Parkinson’s symptoms. Most symptoms stem from a lack of the chemical dopamine in the brain. Many PD medicines either temporarily replenish dopamine or mimic its action.
Levodopa, which converts to dopamine, paired with carbidopa, is considered a first-line drug for improving movement challenges, such as tremor and slowness, and other PD movement symptoms. It can dramatically improve quality of life and can be delivered in a variety of formulations, including carbidopa/levodopa immediate, controlled and extended release, as well as preparations that can be inhaled or delivered through a surgically implanted tube in the small intestine. As Parkinson’s progresses, people may need to take levodopa more frequently to maintain good symptom control.
What are motor fluctuations, “wearing off” and “on-off” times?
Motor fluctuations are changes in the ability to move.
“On” time is when Parkinson’s medications (levodopa and dopamine agonists) take effect and you experience periods of good symptom control.
“Wearing off” is when the drugs begin to lose effect and there are periods where symptoms worsen and movement becomes more difficult, known as “off” time.
Monoamine oxidase-B (MAO-B) inhibitors that make more dopamine available in the brain to improve movement symptoms. These include rasagiline, selegiline and safinamide.
Dopamine agonists to stimulate the parts of the brain influenced by dopamine — tricking the brain into thinking it is receiving the dopamine it needs. These include apomorphine, pramipexole, pramipexole ER, Ropinirole, Ropinirole XL and transdermal Rotigotine.
Catechol-O-methyl transferase (COMT) inhibitorsentacapone, tolcapone and opicapone, which help with changes in the ability to move as levodopa wears off. Carbidopa-levodopa-entacapone improves motor fluctuations while lengthening the benefits of levodopa.
Antiglutamatergic medication amantadine. This can improve tremor and involuntary movements called dyskinesia that sometimes begin within a few years of taking levodopa. Its extended-release forms come in tablets and capsules.
Anticholinergics benztropine, biperiden and trihexyphenidyl. These are used for tremor and dystonia, painful cramping, in younger people. However, research shows cognitive slowing is a side effect of anticholinergics. These medications can also cause confusion and hallucinations in older adults and should not be used in people over 70.
Adenosine A2A antagonist istradefylline can reduce PD-related movement difficulties as levodopa wanes, known as “wearing off.”
Always talk to your Parkinson’s doctor about any medication concerns and side effects.
Room to Grow
There are several PD treatment options in the development pipeline. For some people with PD, current dopamine medicines fail to sufficiently address symptoms. Newer formulations that further improve and extend delivery are nearing approval. These drugs can minimize motor fluctuations and wearing off symptoms.
Two options for continuous levodopa infusion therapy are closer to getting the green light:
ABBV-951: AbbVie has completed trials and filed for U.S. Food and Drug Administration (FDA) approval of a carbidopa/levodopa formulation designed for continuous delivery under the skin, which aims to increase “on” time by reducing motor fluctuations.
ND0612: NeuroDerm recently completed clinical trials and is awaiting data on this new drug, which is a continuous subcutaneous carbidopa/levodopa infusion formula. The company expects to apply this year to U.S. and European regulatory industries for approval.
Studies have also been completed and published showing under-the-skin dopamine agonist apomorphine infusions can improve motor fluctuations in PD. Data has been submitted to the FDA for drug approval and is currently available in Europe.
For people newly diagnosed with Parkinson’s disease, P2B001 is a low-dose, extended-release formulation of pramipexole and rasagiline in development for the treatment of movement symptoms.
The FDA is reviewing Amneal’s IPX203, an extended-release carbidopa/levodopa tablet designed to extend PD symptom control while minimizing motor fluctuations.
In development, but further from the approval process, is Tavapadon, a once-daily tablet designed by Cerevel Therapeutics. It aims to target and activate certain dopamine receptors to improve PD motor symptoms while minimizing side effects sometimes related to other Parkinson’s therapies.
There is an active and ever-growing landscape of therapeutic trials aimed at slowing disease progression. In Parkinson’s, the protein alpha-synuclein misfolds and forms clumps in the brain called Lewy bodies. There are a number of experimental therapies in early development to either reduce alpha-synuclein production or minimize the forming of such clusters.
Though data from recent frontrunners targeting alpha-synuclein (prasinezumab and cinpanemab) failed to show slowing of PD progression, it can take decades to discover disease-modifying therapies.
A class of drugs approved to treat type 2 diabetes has also attracted a lot of attention for its potential to slow PD progression. Scientists across different studies in various stages of development are examining whether glucagon-like peptide-1 (GLP-1) receptor agonists can modify PD and improve symptoms.
Nilotinib, a drug approved for management of cancer, selectively inhibits tyrosine kinases, enzymes found in excess in some cancer cells. Tyrosine and other kinases have been linked to PD. Though studies of nilotinib did not improve PD biology, it was safe and tolerable in the small number of selected participants. Now, other novel cancer therapies are in the early stages of testing for potential effectiveness in PD.
There is also a lot of interest across neurodegenerative disease research in the gut-brain connection. This highlights the need for more studies that examine the role of inflammation in Parkinson's disease development.
PD and Personalized Medicine
Every person with Parkinson's experiences symptoms differently. Developing therapies to target the biology of PD in a particular individual is known as personalized medicine. Genetic targeting is the most advanced way to subtype drug development for people with PD.
While those with Parkinson’s who carry a PD-related gene mutation currently constitute a minority of people with Parkinson's, the biology that drives their disease can be relevant even to people who do not carry the same mutation.
Researchers are investigating possible therapeutic interventions for two PD-related genes:
GBA, the most common Parkinson’s-related gene mutation, carried by up to 10% of people who live with the disease.
LRRK2, the gene variants involved in about 1% of all PD diagnoses and 5% of those for people with a family history.
PD GENEration is a global initiative that offers comprehensive genetic testing and counseling for PD-related genes at no cost for people with Parkinson’s. It is critical to helping people determine whether they are candidates for gene-targeted medicine clinical trials. Knowledge of genetic status can also be important for therapeutic decision-making and for understanding individual disease progression, as well as potential implications for family.
Exercise, for example, is essential to managing many Parkinson’s symptoms and maintaining good function. Finding someone to talk to, such as a mental health therapist, can help you build coping skills and learn stress-easing strategies.
Helpful Resources
Explore more of our Parkinson’s management resources now:
My adventure with Parkinson’s disease (PD) started 19 years ago when my primary care physician noticed a slight tremor in my hand and sent me to a neurologist for tests. One year later, I was diagnosed with Parkinson’s. I have been pleased under his care, as he has been cautious increasing dosages, and has not been too quick to introduce new PD medications. Now that my needs are increasing, I am thankful he didn't prescribe too much too soon.
A few years ago, I started a PD support group at my church. I reached out to the Parkinson's Foundation Helpline — at 1-800-4PD-INFO (1-800-473-4636) — for information and was grateful for their provision of both basic and more advanced information. The support group was successful, with a monthly attendance of about 15 people, including caregivers. As time passed, I became overwhelmed with preparation and leading the meetings, so the group disbanded.
Sharing some of my bumps in the road... have you ever hallucinated? One day I saw a cute mouse, dressed in a tuxedo. He ran from the kitchen to where I was sitting at my computer, he saw me and ran back. I set mouse traps. Days later, when he neither reappeared nor got caught, I realized he did not exist.
I take three pills during the night (2 a.m. and 4 a.m.). This has been the answer to help me wake in the morning and take PD medications with breakfast, then waiting until noon before I have the energy or balance to do anything other than sit. It took about two weeks to fine-tune the timing. I hadn't told my neurologist what I was trying. I called the Parkinson's Foundation Helpline for their opinion of my unusual scheduling and was advised to discuss it with my doctor. He gave me a green light.
My physician and neurologist are both retiring. I am not happy. So, I called the Parkinson's Foundation Helpline for recommendations of PD specialists in my area. Although they provided some, they were too far for me to drive. I am exploring local neurologists, and trusting God to lead where He thinks best for me. I am in good spirits and try to give a listening ear and TLC to homebound friends. My hubby of 62 good years and I laughed a lot, and I continue (he passed six years ago) to.
I connected with the Parkinson's Foundation Helpline several years ago, and I view it as an always open door for help. I have appreciated them from day one. Without my hubby and my retiring doctors, I have almost found a "second home" with the Parkinson’s Foundation information specialists.
With every phone call to the Parkinson's Foundation Helpline, I ask for advice, information or opinion on minor and major issues connected to PD. I have always been connected to a patient, pleasant, interested, caring and knowledgeable Parkinson’s information specialist... who becomes more like a friend by the time I hang up.
Parkinson’s is not the end of my story. I believe that with God's guidance, family, friends and the Parkinson's Foundation, I may have a few more years to enjoy life.
I was diagnosed with Parkinson's disease (PD) in 2013, after over a year of my symptoms being misdiagnosed. My husband and I were dumbfounded. Neither of us had anyone with Parkinson's in our families, and we knew nothing about the disease. While searching online for information about PD, I found the Parkinson's Foundation and decided to call the Helpline.
I talked to a Helpline specialist, who guided me through the Foundation’s resources and told me about a five-day workshop taking place not far from my home in Pennsylvania. My husband and I attended the workshop, and we were submerged in education, exercise, support groups and comradery. It was the best thing we could have done. I sat in on seminars led by doctors who stayed long after they were scheduled to speak, just to answer questions from attendees.
The workshop took place three months after my diagnosis. Up until this point, I had not cried. For days, tears poured out of me during these sessions — I felt this was expected, because there were boxes of tissues throughout the room. I left after five days feeling empowered by a better understanding my disease. I no longer felt alone.
My husband understood what I was going through. We came home from the workshop knowing others in our area living with Parkinson's. This was just the beginning of our journey in bringing Parkinson's awareness and resources to this corner of Pennsylvania. We started an annual 5k race that took place five years in a row, raising over $200,000 for Parkinson's research.
I became involved in clinical studies for Parkinson's research. One of these studies, which is being conducted in research centers around the world, is looking for biomarkers to diagnose and prevent PD. In 2020, I had deep brain stimulation (DBS) surgery. I continue to share my experience with DBS and serve as a resource for others considering the surgery. I also make a difference by volunteering with the Parkinson's Foundation.
My continued involvement with the PD community has helped me feel like my experience with Parkinson's happened for a reason. My journey has been made easier by my family. My husband has been by my side since we attended the workshop together. He understands my challenges. My husband, along with our three children and their spouses, were tremendously involved in the success of the 5k. The support I have been given by my family has made this journey easier.
Episodio 24: Cambios en la vista relacionados con el Parkinson
La visión es uno de los sentidos que tenemos que está conectado directamente con el sistema nervioso central. Cuando hay alguna enfermedad neurológica o algún problema que afecta esta área del cerebro, podemos esperar cambios en la visión.
En este episodio, hablamos con el doctor Juan Ramírez-Castañeda, profesor asociado de neurología en la University of Texas at San Antonio y director del programa de la enfermedad de Parkinson y otros trastornos del movimiento, acerca de estos cambios en la vista relacionados con el Parkinson.
El doctor Ramírez-Castañeda explica cuáles son los síntomas visuales más comunes para las personas con Parkinson, como visión doble, ojos resecos, problemas con la percepción de profundidad y alucinaciones visuales y cómo pueden tratarse los cambios en la visión.
Publicado: 21 de marzo de 2023
El Dr. Juan Ramírez-Castañeda completó sus estudios de medicina en la Pontificia Universidad Católica del Ecuador. Realizó su residencia en neurología y subespecialidad en trastornos del movimiento en Baylor College of Medicine en Houston, Texas. Actualmente es profesor asociado de neurología en las University of Texas at San Antonio, donde ha estado por los últimos 8 años. Ahí se desempeña como director del programa de la enfermedad de Parkinson y otros trastornos del movimiento. Recientemente, asumió el papel de jefe de la división de trastornos del movimiento en su institución. Sus intereses principales incluyen el manejo integral de la enfermedad de Parkinson, la estimulación cerebral profunda y la investigación clínica.
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